| NPI | 1770787087 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | WANDA DITTHARDT Office Manager 954-964-4113 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME62894) | 
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME64761) | 
| Enumeration Date | 2007-06-12 | 
| Last Update Date | 2020-08-22 |